The list of diagnostic tests mentioned in various sources as used in the diagnosis of Primary pulmonary hypertension includes:
These home medical tests may be relevant to Primary pulmonary hypertension:
Hypertension is the medical term for an abnormally high blood pressure. Normal mean pulmonary-artery pressure is approximately 14 mm Hg at rest. In the PPH patient, the mean blood pressure in the pulmonary artery is greater than 25 mm Hg at rest and 30 mm Hg during exercise. This abnormally high pressure (pulmonary hypertension) is associated with changes in the small blood vessels in the lungs, resulting in an increased resistance to blood flowing through the vessels. (Source: excerpt from NHLBI, Facts About Primary Pulmonary Hypertension: NHLBI)
PPH is rarely picked up in a routine medical examination. Even in its later stages, the signs of the disease can be confused with other conditions affecting the heart and lungs. Thus, much time can pass between the time the symptoms of PPH appear and a definite diagnosis is made.
PPH remains a diagnosis of exclusion. This means that it is diagnosed only after the doctor finds pulmonary hypertension and excludes or cannot find other reasons for the hypertension, such as a chronic obstructive pulmonary disease (chronic bronchitis and emphysema), blood clots in the lung (pulmonary thromboemboli), or some forms of congenital heart disease.
The first tests for PPH help the doctor determine how well the heart and lungs are performing. If the results of these tests do not give the doctor enough information, the doctor must perform a cardiac catheterization. The procedure, discussed below, is the way the doctor can make certain that the patient's problems are due to PPH and not to some other condition.
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The electrocardiogram (ECG) is a record of the electrical activity produced by the heart. An abnormal ECG may indicate that the heart is undergoing unusual stress.
In addition to the usual ECG performed while the patient is at rest, the doctor may order an exercise ECG. This ECG helps the doctor evaluate the performance of the heart during exercise, for example, walking a treadmill in the doctor's office.
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In an echocardiogram, the doctor uses sound waves to map the structure of the heart by placing a slim device that looks like a microphone on the patient's chest. The instrument sends sound waves into the heart, which then are reflected back to form a moving image of the beating heart's structure on a TV screen. A record is made on paper or videotape. The moving pictures show how well the heart is functioning. The still pictures permit the doctor to measure the size of the heart and the thickness of the heart muscle; in the patient with severe pulmonary hypertension, the still pictures will show that the right heart is enlarged, while the left heart is either normal or reduced in size. Echocardiograms are helpful in excluding some other causes of pulmonary hypertension and can be useful in monitoring the response to treatment.
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A variety of tests called pulmonary function tests (PFTs) evaluate lung function. In these procedures, the patient, with a nose clip in place, breathes in and out through a mouthpiece. The patient's breathing displaces the air held in a container suspended in water. As the container rises and falls in response to the patient's breathing, the movements produce a record, or spirogram, that helps the doctor measure lung volume (how much air the lungs hold) and the air flow in and out of the lungs. Some devices measure air flow electronically.
A mild restriction in air movement is commonly seen in patients with PPH. This restriction is thought to be due, in part, to the increased stiffness of the lungs resulting from both the changes in the structure and the high blood pressure in the pulmonary arteries.
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Two patterns of pulmonary perfusion are seen in patients with PPH. One is a normal pattern of blood distribution; the other shows a scattering of patchy abnormalities in blood flow.
A major reason for doing a perfusion scan is to distinguish patients with PPH from those whose pulmonary hypertension is due to blood clots in the lungs.
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During catheterization, the doctor can also evaluate the right heart's pumping ability; this is done by measuring the amount of blood pumped out of the right side of the heart with each heartbeat.
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